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General NPI Number Information
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NPI Number | 1700481397
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Entity Type | Individual
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Provider Name | SUZANNE PODREBARAC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1402 E LAKE MEAD PKWY
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City | HENDERSON
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State | NV
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Zip | 89015-4600
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Country | US
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Telephone | 702-558-5101
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Fax |
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Provider Business Mailing Address
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Address Line | 7450 S EASTERN AVE UNIT 1047
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City | LAS VEGAS
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State | NV
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Zip | 89123-1559
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Country | US
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Telephone | 702-232-7719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10705
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License Number State | NV
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